Causal attributions in delusional thinking: an investigation using qualitative methods

To investigate the attributions offered spontaneously during interview by patients who have delusional beliefs. Specifically, to assess whether people with delusional beliefs reason in a way that is analysable. If so, to extend the findings from previous research to provide a detailed picture of the patients' accounts that could inform cognitive therapies for psychosis.

A group of 31 patients with delusional beliefs were interviewed using a semi-structured open-ended interview. Their causal attributions were identified and analysed in terms of standard definitions of attributional theory using the Leeds Attributional Coding System.

Patients made an average of 96 attributions each. These showed a high degree of recognizable coherence in reasoning, including when directly discussing delusional beliefs. The patterns of attributing were partly consistent with previous research findings, with external attributions being offered for negative events. Several other aspects emerged, indicating a pervasive negativity, with non-delusional aspects of the illness being a major concern. When delusions were described as a cause of events, the dominant pattern of attributing was stable, internal, personal and uncontrollable, with negative outcomes. When delusions were reported as an outcome, the patient was more in control.

The reasoning processes of patients with delusional beliefs are in many aspects normal and include patterns not identified by the ASQ. Attributing in relation to delusions differs from talk about other subjects. The qualitative attributional approach provided a detailed and rich picture of the world of these patients. Interpretable tendencies are described that should provide information useful to those practising and evaluating cognitive therapies.